Neonatal Resuscitation

Introduction:

Neonatal resuscitation provides life-saving care to newborns in respiratory or cardiac distress. The Neonatal Resuscitation Program (NRP) is a course that teaches healthcare providers how to recognize and manage newborns who require resuscitation. It is a course that The American Academy of Pediatrics put together to help reduce the cognitive load of neonatal resuscitation, taking some stress off of you if you follow these guidelines.

Starting the NRP

Something important to know about the NRP is that it takes place the moment the newborn is delivered. These steps below are even before your 1-minute APGAR score, and these help you get a good reliable APGAR score. These are all for the first 60 seconds after birth, with a reevaluation happening at 30 seconds in. Here are the steps of neonatal resuscitation according to NRP guidelines:

Step 1. Assess the Newborns Condition

Check the newborn’s airway, breathing, and circulation (ABCs).

If the newborn is not breathing or has weak, irregular respirations, proceed immediately to step 2.

If the newborn has a strong cry and good muscle tone and is pink and warm, do not interfere and observe the newborn closely.

Step 2. Open the Airway

Position the newborn on their back with the head in a neutral position. Pad behind the chest, not the head to allow them to be in a neutral position. 

If the newborn has thick secretions or visible obstruction in the mouth, suction the mouth and nose with a bulb syringe or suction device. (should have one in the OB kit on an ambulance!)

Step 3. Provide Ventilation

If the newborn is not breathing or has weak, irregular respirations, provide ventilation with a bag and mask.

If the newborn has a strong cry and good muscle tone and is pink and warm, do not interfere and observe the newborn closely. Proceed to step 4, and then 7 most likely

Step 4. Check the Pulse

Check the newborn’s pulse by feeling for a pulse on the inside of the upper arm or the chest just below the collarbone.

If the pulse is less than 60 beats per minute, proceed to step 5.

If the pulse is greater than or equal to 60 beats per minute, continue ventilation and reassess the pulse every minute.

Step 5. Provide Chest Compressions

If the newborn’s pulse is less than 60 beats per minute, provide chest compressions using two fingers or the heel of your hand.

Continue ventilation and chest compressions until the pulse improves or medical help arrives.

Step 6. Administer Medications (AEMT and Paramedic)

If the newborn’s condition does not improve with ventilation and chest compressions, administer medications as directed by NRP guidelines and as ordered by a healthcare provider. These medications are going to be epinephrine if they remain in bradycardia and normal saline or other crystalloid fluids. 

Step 7. Reassess and Continue Care

Continuously reassess the newborn’s ABCs and pulse, and adjust care as needed.

If the newborn’s condition improves, provide ongoing care and observe the newborn closely.

Closing

If you find yourself in a situation where you are doing any of the above, and you are in an ambulance, this may be one of the worst days of your life as far as stress goes. You’ve just delivered a newborn, you already have the mom as a patient – and now you’ve just added another. Be sure to use your resources, and do what makes sense. Call for additional resources, and remember to train often. You will never rise to the occasion, you fall to your greatest level of training. While there is not a shortage of resources or guides to these things all over the internet, the list above is very concise and to the point over the main idea. If you’re interested in additional resources, we have a brief study guide for all the main systems available for free, with even more available if you subscribe and create a paid account today.